person
Ketrick Devon Pendergrass I
Addiction (Substance Use Disorder) Counselor in Coburg, Oregon
NPI 1992412035

Ketrick Devon Pendergrass I is an Addiction (Substance Use Disorder) Counselor based in Coburg, OR and is specialized in Addiction (Substance Use Disorder). Ketrick Devon Pendergrass I practices in Coburg, OR. The NPI Number for Ketrick Devon Pendergrass I is 1992412035 and holds a License No. (Oregon).

The current practice location address for Ketrick Devon Pendergrass I is 1 Serenity Ln, Coburg, OR and can be reached out via phone at 541-687-1110.

Location: 1 Serenity Ln, Coburg, OR, 97408-9350
person
Provider Profile Details
NPI Number
1992412035
Provider Name
Ketrick Devon Pendergrass I
Credential
Provider Entity Type
Individual
Gender
Male
Address
1 Serenity Ln, Coburg, OR, 97408-9350
Phone Number
541-687-1110
Fax Number
Provider Enumeration Date
10/28/2022
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
1 Serenity Ln
City
State
Zip
97408-9350
Phone Number
541-687-1110
Fax Number
person
Provider Business Mailing Address Details
Address
1 Serenity Ln
City
State
Zip
97408-9350
Phone Number
541-687-1110
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
License No.
()
Definition
Definition to come...
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